CARE NH: Community Alliance Reform Effort
Manchester, Littleton, and Berlin, New Hampshire
The objective of CARE NH is to model collaboration at the State level and to ensure access to a full array of community-based services that is guided by system-of-care principles. The concept was initiated through the CCMC, and members of this group have continued on as the core of the State-level governing body for the grant. From 1997 to 1999, groups representing families and key agencies met in each of the three regions to improve collaboration, to increase understanding of system-of-care principles, and to develop regional planning teams in order to apply for a Federal Children’s Mental Health Services (CMHS) grant. They performed local needs assessments and initial data collection to establish baselines for measuring results. In 1999, the sites applied for State health care planning grant funds to formalize boards in each Regional Collaborative, to develop plans and take action to increase participation of ethnic and minority community members, and to develop a cultural competence and training plan for each site.
CARE NH serves three regions: Littleton-Lancaster-Woodsville and Berlin-Gorham in northern New Hampshire, and Manchester in southern New Hampshire. These regions were selected partly because they are culturally and geographically representative of New Hampshire’s urban southern and rural northern areas. The total population of the Littleton-Lancaster-Woodsville region was estimated at 30,939 in 2001. Of this total, almost 98 percent are White and English-speaking. Many people living in this rural region are impoverished; 11 percent of the population of Littleton has an income below the poverty line. The target population is children from 3 to 22 years of age who have serious emotional disturbance as defined by State criteria (DSM–IV diagnosis and psychosocial impairment as defined by the Child and Adolescent Functional Assessment Scale [CAFAS]). Children in the 0−3-year old age group can be enrolled in CARE NH via a waiver. Eligibility for CARE NH also requires multi-agency involvement and the risk of out-of-home placement or current placement out of the home. The first child was enrolled in CARE NH in June 2000. From September 2004 to July 2005, 65 children have been referred for service, and 44 of those children met entrance criteria and received services (11 in Berlin, 10 in LLW, 23 in Manchester). A total of 392 children have been referred to CARE NH, and of these, 259 have been served by the grant since its beginning in 1999. Not surprisingly, Manchester has had more children referred and enrolled (191; 138) than Littleton (101; 58) and Berlin (100; 63). There are 117 children currently active in the program.